Provider Demographics
NPI:1063734341
Name:MANWILL, RETA NICHOLE (DEM)
Entity type:Individual
Prefix:
First Name:RETA
Middle Name:NICHOLE
Last Name:MANWILL
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:RETA
Other - Middle Name:NICHOLE
Other - Last Name:PARTNER-PREECE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DEM
Mailing Address - Street 1:270 COATSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1927
Mailing Address - Country:US
Mailing Address - Phone:801-415-9888
Mailing Address - Fax:801-521-0196
Practice Address - Street 1:270 COATSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1927
Practice Address - Country:US
Practice Address - Phone:801-415-9888
Practice Address - Fax:801-521-0196
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay